Module 1 - Central Nervous System Part 1 copy

▪ progressive neurogenerative ▪ dopamine

Parkinson's disease is a ________________ _________________ disorder that affects the __________ producing neurons in the brain.

• Since there is genetic predisposition, having a first-degree relative such as a parent or sibling with MS increases a person's risk of developing the disease. • The exact cause of MS remains unknown and is very complex. Viruses are well recognized as causes of demyelination and inflammation.

Who is at risk for development of MS?

*Environment* ▪ calm ▪ well-lit ▪ minimal distractions (NO abstract paintings) ▪ consistent routine *Reminiscence Therapy* ▪ labeled photos of family members and friends *Orientation Therapy* ▪ clock ▪ single date calendar *Validation Therapy* ▪ validate the client's concerns

Nursing Interventions: *Alzheimer's Disease*

C. Increase fluid intake.

A nurse is caring for a client who reports a throbbing headache after a lumbar puncture. Which of the following actions is most likely to facilitate resolution of the headache? A. Administer pain medication. B. Darken the client's room and close the door. C. Increase fluid intake. D. Elevate the head of the bed to 30º.

*Multiple sclerosis (MS)* is a chronic autoimmune disease that affects the myelin sheath and conduction pathway of the central nervous system and is a leading cause of neurologic disability in young adults.

Define Multiple Sclerosis

a medical emergency characterized by prolonged seizures lasting > 5 minutes or repeated seizures over the course of 30 minutes; a potential complication of all types of seizures.

Define Status Epilepticus

A migraine headache is a common clinical syndrome characterized by recurrent episodic attacks of head pain that serve no protective purpose.

Define a Migraine Headache

▪ maintain cognitive function for as long as possible as well as keep the client safe

Goal of Care: *Alzheimer's Disease*

• Remission • Exacerbation (heat, infection)

List the two cycles of MS and define them

*Meningitis*: 2-week course of IV antibiotics. Drug therapy should begin within 1 to 2 hours after it is prescribed. Monitor and document the patient's response. **DROPET PRECAUTIONS, elevate bed 30 degrees** *Encephalitis*: Drug therapy is most effective if begun early, before the patient becomes stuporous or comatose. • No specific drug therapy is available for infection by arboviruses or enteroviruses. • Teach older adults and those with chronic illness to have influenza and pneumonia vaccines. • Since encephalitis can be caused by certain types of bites, teach people who enjoy outdoor activities to avoid areas where mosquitoes and ticks are likely to populate, especially near lakes and wooded areas. If they are in contact with these areas, remind them (especially older adults) to use insect repellent and keep skin exposure at a minimum.

Meningitis & Encephalitis: *How are they treated?*

▪ Mematine (Namenda) - drug of choice, slows the pace of deterioration ▪ SSRIs (paroxetine, sertraline) ▪ Psychotropics - last resort, form of restraint

Pharmaceutic Treatment: *Alzheimer's Disease*

*Hyperflexion* ▪ a sudden and forceful acceleration (movement) of the head forward, causing extreme flexion of the neck. ▪ EX: head-on motor vehicle collision or diving accident. Spinal cord easily damaged. *Hyperextension* ▪ The head is suddenly accelerated and then decelerated. This stretches of tears the anterior longitudinal ligament, fractures of subluxates the vertebrae, and perhaps ruptures an intervertebral disk. Spinal cord easily damaged. ▪ EX: vehicle collisions in which the vehicle is struck from behind or during falls when the patient's chin is struck. *Vertical Compression or Axial Loading* ▪ A blow to the top of the head can cause the vertebrae to shatter. Pieces of bone enter the spinal canal and damage the cord. ▪ EX: diving accidents, falls on the buttocks, or a jump in which a person lands on the feet. *Excessive Rotation* ▪ results from injuries that are caused by turning the head beyond the normal range. *Penetrating Trauma* ▪ is classified by the speed of the object (e.g., knife, bullet) causing the injury.

There are several classifications of spinal cord injuries (SCI). Define each and list an example a. Hyperflexion b. Hyperextension c. Vertical Compression or Axial Loading d. Excessive Rotation e. Penetrating Trauma

▪ women ▪ family history

What are the risk factors associated with migraine headaches?

What is a normal GCS? ____15________ a. What score is considered Mild impairment?____14-15______________ b. What score is considered Moderate impairment?_____9-13__________ c. What score is considered Severe impairment?______3-8_____________

What is a normal GCS? ____________ a. What score is considered Mild impairment?_____ b. What score is considered Moderate impairment?____ c. What score is considered Severe impairment?______ Workbook

A. Obtain IV access.

A nurse working on a medical unit is caring for a client who is prescribed seizure precautions. Which of the following interventions should the nurse include in the client's plan of care? A. Obtain IV access. B. Keep the lights on when the client is sleeping. C. Place the client's bed in the high position. D. Keep a padded tongue blade available at the client's bedside.

*Stage I* ▪ No apparent symptoms ▪ - There is no apparent decline in memory despite changes that are beginning to occur in the brain. A positron emission tomography (PET) scan can be used to detect these changes. *Stage II* ▪ Forgetfulness/Very Mild Changes ▪ - Losses in short term memory are frequent. The individual begins to lose things or forget names of people. - The individual is aware of the intellectual decline and may feel ashamed, becoming anxious and depressed, which in turn may worsen the symptoms. - Maintaining organization with lists and a structured routine provides some compensation. - These symptoms often are not noticed by others and do not interfere with the individual's ability to work or live independently. *Stage III* ▪ Mild cognitive decline ▪ - In this stage, there is interference with performance, and this becomes noticeable to others. There is difficulty recalling names or words. A downturn is noticeable to family and close associates. - The individual may get lost when driving his or her car. - Concentration may be interrupted. There is difficulty recalling names or words, which becomes noticeable to family and close associates. - A decline occurs in the ability to plan or organize. *Stage IV* ▪ Mild to Moderate Cognitive Decline ▪ - The individual may forget significant events in history, experience a declining ability to perform tasks. He/she may deny a problem exists by covering memory loss with confabulation. - The individual may forget major events in personal history, such as his or her child's birthday; experience declining ability to perform tasks, such as shopping and managing personal finances; or be unable to understand current news events. - Depression and social withdrawal are common. At this stage, the individual requires some assistance to maintain safety. *Stage V* ▪ Moderate cognitive decline ▪ - At this stage, individuals lose the ability to independently perform some ADLs and require some assistance to manage these tasks on an ongoing basis. - They may forget addresses, phone numbers, and names of close relatives. - They may become disoriented about place and time, but they maintain knowledge about themselves. - Frustration, withdrawal, and self-absorption are common. *Stage VI* ▪ Moderate to severe cognitive decline ▪ - Disorientation to surroundings is common and may not know the day, season, or year. - The person is also unable to manage ADLs without assistance. Urinary and fecal incontinence are common. - Psychomotor symptoms include wandering, agitation, and aggression. Symptoms seem to worsen in late afternoon and evening (sundowning). - At this stage, individuals may be unable to recall the name of their spouse or may misidentify people (e.g., thinking a child is their spouse). - Delusions often become apparent, such as maintaining the belief that one must go to work even though the person is no longer employed. - Sleeping becomes a problem. - Communication becomes more difficult, with increasing loss of language skills. Institutional care is usually required at this stage. *Stage VII* ▪ Severe cognitive decline ▪ - In the end stages, the individual is unable to recognize family members (**agnosia**). He/she most commonly confined to bed and aphasic. - Problems of immobility, such as decubiti and contractures, may occur.

7 stages of Alzheimer's disease & defining characteristics

D. Place the client in a sitting position.

A nurse is caring for a client who has a spinal cord injury and suspects the client is developing autonomic dysreflexia. Which of the following actions should the nurse take first? A. Check the client for a fecal impaction. B. Examine the client for areas of skin breakdown. C. Check the client's bladder for distention. D. Place the client in a sitting position.

A. Evaluate the client's neurological status.

A nurse at a community health clinic is caring for a client who reports a headache and stiff neck. Which of the following actions should the nurse take first? A. Evaluate the client's neurological status. B. Perform a complete blood count. C. Check the client's temperature. D. Administer an oral analgesic.

C. Take the client to the bathroom every 2 hr.

A nurse in a long-term care facility is caring for an older adult client who has dementia and begins to have frequent episodes of urinary incontinence. After the provider determines no medical cause for the client's incontinence, which of the following interventions should the nurse initiate to manage this behavior? A. Remind the client to tell the nurse when he has to urinate. B. Use adult diapers to prevent frequent clothing changes. C. Take the client to the bathroom every 2 hr. D. Request a prescription for an indwelling urinary catheter.

C. Ask the partner to talk about his difficulties in caring for the client.

A nurse in an acute care facility is admitting an older adult client who has dementia due to Alzheimer's disease. The nurse notes that the client's partner appears exhausted. He states that he is finding it more and more difficult to care for his wife. Which of the following interventions is the nurse's priority? A. Recommend that the partner place the client in a long-term care facility. B. Suggest that the partner see a counselor to help him cope with his exhaustion. C. Ask the partner to talk about his difficulties in caring for the client. D. Tell the partner to call a family meeting to get help.

C. Bradykinesia

A nurse is assessing a client who has Parkinson's disease. Which of the following manifestations should the nurse expect? A. Pruritus B. Hypertension C. Bradykinesia D. Xerostomia

C. Brudzinski's sign

A nurse is assessing a client who has meningitis and notes when passively flexing the client's neck there is an involuntary flexion of both legs. Which of the following conditions is the client displaying? A. Kernig's sign B. Nuchal rigidity C. Brudzinski's sign D. Bradykinesia

A. Severe headache

A nurse is assessing a client who has meningitis. Which of the following findings should the nurse expect? A. Severe headache B. Bradycardia C. Blurred vision D. Oriented to person, place, and year

D. Place the child in isolation.

A nurse is caring for a child who has a suspected diagnosis of bacterial meningitis. Which of the following actions is the nurse's priority? A. Prepare the child for a lumbar puncture. B. Administer an intravenous antibiotic. C. Obtain blood cultures. D. Place the child in isolation.

B. Position the child side-lying.

A nurse is caring for a child who is having a tonic-clonic seizure and vomiting. Which of the following actions is the nurse's priority? A. Place a pillow under the child's head. B. Position the child side-lying. C. Loosen restrictive clothing. D. Clear the area of hazards.

B. The client's bladder becomes distended.

A nurse is caring for a client who has a T-4 spinal cord injury. Which of the following client findings should the nurse identify as an indication the client is at risk for experiencing autonomic dysreflexia? A. The client states having a severe headache. B. The client's bladder becomes distended. C. The client's blood pressure becomes elevated. D. The client states having nasal congestion.

C. "Tell me what you like to cook for dinner."

A nurse is caring for a client who has dementia due to Alzheimer's disease and was admitted to a long-term care facility following the death of her partner of 40 years. The client states, "I want to go home; my husband is waiting for me to cook dinner." Which of the following responses by the nurse is appropriate? A. "This is where you live now." B. "This is a safer place for you to live." C. "Tell me what you like to cook for dinner." D. "Your family said there is no one to care for you at home."

D. Paraplegia

A nurse is caring for a client who has had a spinal cord injury at the level of the T2-T3 vertebrae. When planning care, the nurse should anticipate which of the following types of disability? A. Paresthesia B. Hemiplegia C. Quadriplegia D. Paraplegia

C. Place the client in a high-Fowler's position.

A nurse is caring for a client who has quadriplegia from a spinal cord injury and reports having a severe headache. The nurse obtains a blood pressure reading of 210/108 mm Hg and suspects the client is experiencing autonomic dysreflexia. Which of the following actions should the nurse take first? A. Administer a nitrate antihypertensive. B. Assess the client for bladder distention. C. Place the client in a high-Fowler's position. D. Obtain the client's heart rate.

C. "He has so many new bruises on his body."

A nurse is caring for an adolescent client who is receiving carbamazepine for partial seizure disorder. Which of the following statements by the client's parent is the nurse's priority? A. "He takes a 2-hour nap every day after school." B. "He says he feels sick to his stomach after taking this medication." C. "He has so many new bruises on his body." D. "He says his mouth is always dry."

D. Ability to self-feed with the use of adaptive equipment

A nurse is developing a plan of care for a client who has a spinal fracture and complete spinal cord transection at the level of C5. Which of the following rehabilitation goals should the nurse add to the client's plan of care? A. Ability to achieve independent transfer from bed to wheelchair B. Independent control of bowel and bladder function C. Use of a wheelchair with a chin or mouth stick D. Ability to self-feed with the use of adaptive equipment

D. "I'll be glad when I can stop taking this medicine."

A nurse is performing discharge teaching for a client who has seizures and a new prescription for phenytoin. Which of the following statements by the client indicates a need for further teaching? A. "I will notify my doctor before taking any other medications." B. "I have made an appointment to see my dentist next week." C. "I know that I cannot switch brands of this medication." D. "I'll be glad when I can stop taking this medicine."

C. Measure head circumference every shift.

A nurse is planning care for a 6-year-old child who has bacterial meningitis. Which of the following nursing interventions is unnecessary in the client's plan of care? A. Place the client in a semi-Fowler's position. B. Admit the client to a private room. C. Measure head circumference every shift. D. Implement seizure precautions.

B. Administer a saline solution after injection.

A nurse is preparing to administer phenytoin IV to a client who has a seizure disorder. Which of the following actions should the nurse plan to take? A. Administer the medication at 100 mg/min. B. Administer a saline solution after injection. C. Hold the injection if seizure activity is present. D. Dilute the medication with dextrose 5% in water.

D. "Implement a schedule to include periods of rest."

A nurse is presenting discharge instructions to a client who has multiple sclerosis (MS). The client reports symptoms of diplopia, dysmetria, and sensory change. Which of the following nursing statements are appropriate? A. "Wear an eye patch on the right eye at all times." B. "Plan to relax in a hot tub spa each day." C. "Engage in a vigorous exercise program." D. "Implement a schedule to include periods of rest."

A. Provide client supervision.

A nurse is providing teaching to the family of a client who has Parkinson's disease. Which of the following information should the nurse include in the teaching? A. Provide client supervision. B. Limit client physical activity. C. Speak loudly to the client. D. Leave the television on continuously.

D. The client opens his eyes when spoken to.

A nurse is receiving a transfer report for a client who has a head injury. The client has a Glasgow Coma Scale (GCS) score of 3 for eye opening, 5 for best verbal response, and 5 for best motor response. Which of the following is an appropriate conclusion based on this data? A. The client can follow simple motor commands. B. The client is unable to make vocal sound. C. The client is unconscious. D. The client opens his eyes when spoken to.

A. "Do not take antihistamines with this medication."

A nurse is teaching a client who has multiple sclerosis about a new prescription for baclofen. Which of the following instructions should the nurse include in the teaching? A. "Do not take antihistamines with this medication." B. "Take the medication on an empty stomach." C. "Stop taking the medication immediately for a headache." D. "Expect to develop diarrhea initially."

B. Difficulty voiding

A nurse is teaching a client who taking benztropine to treat Parkinson's disease. The nurse should instruct the client to report which of the following adverse effects? A. Excess salivation B. Difficulty voiding C. Diarrhea D. Slow pulse

C. "Use contraception while taking this medication."

A nurse is teaching a female client who has a new prescription for transdermal sumatriptan to treat migraine headaches. Which of the following instructions should the nurse include? A. "Take this medication daily to prevent headaches." B. "Activate the patch 30 minutes after application." C. "Use contraception while taking this medication." D. "You can bathe with the patch in place."

A. Complete a neurological check.

A nurse on a medical unit is caring for a client who suddenly becomes confused and drowsy. Additional data includes pulse 100/min, respiratory rate 24/min, BP 132/76 mm Hg, and temperature 36.8º C (98.2º F). Which of the following actions should the nurse perform? A. Complete a neurological check. B. Administer the prescribed PRN antihypertensive medication. C. Increase the client's fluid intake. D. Hold the client's evening dose of digoxin.

D. Restlessness

A nurse suspects that a client admitted for treatment of bacterial meningitis is experiencing increased intracranial pressure (ICP). Which of the following assessment findings by the nurse supports this suspicion? A. Photophobia B. Nuchal rigidity C. Positive Kernig's sign D. Restlessness

*Autonomic Dysreflexia (AD)*: a potentially life-threatening condition in which noxious visceral or cutaneous stimuli cause a sudden, massive, uninhibited reflex sympathetic discharge in people with high-level SCI. Severely elevated blood pressure can result in a stroke. *Who is at risk?* Occurs with spinal cord injuries above T7-6 *What is the S/S of AD?* • Sudden rise in systolic and diastolic BP accompanied with bradycardia • Profuse sweating above the level of the spinal injury • Goosebumps occur on the skin above the lesion • Flushing of the skin above the level of the lesion • Blurred vision • Changes in vision • Severe throbbing headache *How do we manage complications of AD?* • Monitor vital signs for severe hypertension and bradycardia • Administer antihypertensives (nitrates or hydralazine) **bladder distention and compaction, muscle tone issues with bowel/bladder, see below** *List some interventions to prevent AD*: • Sit the patient down, call the provider. • Insert a catheter for distended bladder using anesthetic ointment on the catheter tip, or check existing catheter for kinks, and irrigate if needed. • Remove fecal impaction (use anesthetic ointment prior to removal). • Adjust the room temperature and block drafts. • Remove tight clothing. • Assess for injury (lower extremity fracture, kidney/bladder infection).

Define Autonomic Dysreflexia (AD) a. Who is at risk? b. What are the S/S of AD? c. How do we manage complications of AD? d. List some interventions to prevent AD

*Spinal Shock*: or spinal shock syndrome occurs immediately as a concussion response to the injury, resulting in flaccid paralysis and **loss of reflex activity.** *How long does it last?* Usually resolves within 24 hours and muscle spasticity begins in patients with cervical or high thoracic injuries *What is the pt. at highest risk for?* Paralytic ileus, breathing problems resulting from reduced MOBILITY or from an interruption of spinal innervation to the respiratory muscle, pressure ulcers due to altered SENSORY PERCEPTION of pressure areas on skin below the level of the injury, venous thromboembolism (VTE), contractures, orthostatic hypotension, fractures related to osteoporosis and high risk for orthostatic hypotension *When does this most often occur?* Immediately after the injury; can last 48 hours to several weeks

Define Spinal Shock a. How long does it last? b. What is the pt at highest risk for? c. When does this most often occur? **Exam**

*Generalized*: Generalized seizure involves both cerebral hemispheres. Generalized seizures can begin with an aura (alteration in vision, smell, hearing, or emotional feeling). *Partial*: Partial or focal/local seizure involves only one cerebral hemisphere. Clients can experience two types of partial seizures: complex and simple. Partial seizures begin in a part of one cerebral hemisphere; some can evolve into generalized tonic-clonic, tonic, or clonic seizures. They are most often seen in adults and in general are less responsive to medical treatment. Also called focal seizures or local seizures. *Complex partial seizure*: Complex partial seizures have associated automatisms (behaviors that the client is unaware of, such as lip smacking or picking at clothes). The seizure can cause a loss of consciousness or blackout for several minutes. Amnesia can occur immediately prior to and after the seizure. *Simple partial seizure*: Consciousness is maintained throughout simple partial seizures. Seizure activity can consist of unusual sensations, a sense of déjà vu, autonomic abnormalities such as changes in heart rate and abnormal flushing, unilateral abnormal extremity movements, pain, or offensive smell.

Define the different types of seizures: a. Generalized b. Partial

*Stage 1: Initial Stage* • Unilateral limb involvement • Minimal weakness • Hand and arm trembling *Stage 2: Mild Stage* • Bilateral limb involvement • Masklike face • Slow, shuffling gait *Stage 3: Moderate Disease* • Postural instability • Increased gait disturbances *Stage 4: Severe Disability* • Akinesia • Rigidity *Stage 5: Complete ADL Dependence*

Describe the 5 stages of Parkinson's disease

▪ Patients who cannot be managed effectively with medication (lorazepam, diazepam) may be candidates for surgery, including vagal nerve stimulation and conventional surgical procedures. ▪ Status epilepticus must be treated promptly and aggressively! Establish an airway and notify the health care provider or Rapid Response Team immediately if this problem occurs! ▪ Establishing an airway is the priority for this patient's care. Intubation by an anesthesia provider or respiratory therapist may be necessary. ▪ Administer oxygen as indicated by the patient's condition. If not already in place, establish IV access with a large-bore catheter and start 0.9% sodium chloride. ▪ The patient is usually placed in the intensive care unit for continuous monitoring and management.

How do we care for a patient in status epilepticus?

▪ maintain patent airway ▪ remain with the client ▪ turn client to side ▪ bed in lowest position ▪ "blow by" oxygen ▪ suction ▪ NPO ▪ do not restrain - keep safe ▪ loosen restrictive clothing ▪ pad the side rails ▪ guide movements if necessary ▪ record the time the seizure started/ended ▪ determine if the patient experienced an aura, which can possibly indicate the origin of seizure in the brain ▪ try to determine possible trigger ▪ client and family support for after care

How should an active seizure be managed?

*I. Preictal phase*: Referring to events that a patient experiences before a seizure, such as the presence of an aura. An aura is a sensation that signals the onset of a headache or seizure; the patient may experience visual changes, flashing lights, or double vision. *II. Tonic phase*: Pertaining to a state of stiffening or rigidity of the muscles, particularly of the arms and legs, and immediate loss of consciousness of a tonic-clonic seizure. *III. Ending (Post-ictal) Phase*: post-ictal stage referring to the time immediately after a seizure (**sleep!!! motor fxn will return to baseline**) **Tonic Clonic - loss of consciousness, incontinence, breathing cessation, 10 min post-ictal phase**

List and define the 3 phases of a seizure

• Allow the patient extra time to respond to questions. • Administer medications promptly on schedule to maintain continuous therapeutic drug levels. • Provide drug therapy for pain and/or tingling in limbs, as needed. • Monitor for drug side effects, especially orthostatic hypotension, hallucinations, and acute confusional state (delirium). • Fall Precautions according to agency protocol. • Collaborate with physical and occupational therapists to keep the patient as mobile and independent as possible in ADLs. • Allow the patient time to perform ADLs and mobility skills; provide assistance only as needed. • Implement interventions to prevent complications of impaired mobility , such as constipation, pressure injuries, and contractures. • Schedule appointments and activities late in the morning to prevent rushing the patient or schedule them at the time of the patient's optimal level of functioning. • Teach the patient to speak slowly and clearly. Use alternative communication methods, such as a communication board or handheld mobile device. Refer to the speech-language pathologist. • Monitor the patient's ability to eat and swallow. Monitor actual food and fluid intake. • Collaborate with the registered dietitian nutritionist to provide high-protein, high-calorie foods or supplements to maintain weight. • Recognize that Parkinson disease can affect the patient's self-esteem. Focus on the patient's strengths. • Assess for depression, anxiety, and impaired cognition. • Assess for insomnia or sleeplessness.

List some nursing interventions to assist a Parkinson's patient

*Type 1: Relapsing-remitting*: type of MS (RRMS) occurs in most cases of MS. The course of the disease may be mild or moderate, depending on the degree of disability. Symptoms develop and resolve in a few weeks to months, and the patient returns to baseline. During the relapsing phase, the patient reports loss of function and the continuing development of new symptoms. *Type 2: Primary progressive*: involves a steady and gradual neurologic deterioration without remission of symptoms. The patient has progressive disability with no acute attacks. Patients with this type of MS tend to be between 40 and 60 years of age at onset of the disease. *Type 3: Secondary progressive*: begins with a relapsing-remitting course that later becomes steadily progressive. About half of all people with RRMS developed SPMS within 10 years. The current addition of disease-modifying drugs as part of disease management may decrease the development of SPMS. *Type 4: Progressive-relapsing*: is characterized by frequent relapses with partial recovery but not a return to baseline. This type of MS is seen in only a small percentage of patients. Progressive, cumulative symptoms and deterioration occur over several years.

List the 4 major types of MS and define each (What makes them different?)

*Meningitis*: analysis of the cerebrospinal fluid (CSF). *Encephalitis*: Brain imaging, spinal tap, electroencephalogram, brain biopsy

Meningitis & Encephalitis: *How are they diagnosed?*

● Females over 65 ● Advanced age ● Family history of AD or Down Syndrome ● Chemical imbalances ● Genetic predisposition, apolipoprotein E ● Environmental agents (herpes virus, metal, or toxic waste) ● Previous head injury ● Ethnicity/race (African American and Hispanic people are at an increased risk)

Risk Factors: *Alzheimer's Disease*

*Early (Mild), or Stage I (First Symptoms up to 4 Years)* • Independent in ADLs • Denies presence of symptoms • Forgets names; misplaces household items • Has short-term memory loss and difficulty recalling new information • Shows subtle changes in personality and behavior • Loses initiative and is less engaged in social relationships • Has mild impaired cognition and problems with judgment • Demonstrates decreased performance, especially when stressed • Unable to travel alone to new destinations • Often has decreased sense of smell *Middle (Moderate), or Stage II (2 to 3 Years)* • Has impairment of all cognitive functions • Demonstrates problems with handling or unable to handle money and finances • Is disoriented to time, place, and event • Is possibly depressed and/or agitated • Is increasingly dependent in ADLs • Has visuospatial deficits: has difficulty driving and gets lost • Has speech and language deficits: less talkative, decreased use of vocabulary, increasingly nonfluent, and eventually aphasic • Incontinent • Psychotic behaviors, such as delusions, hallucinations, and paranoia • Has episodes of wandering; trouble sleeping *Late (Severe), or Stage III* • Completely incapacitated; bedridden • Totally dependent in ADLs • Has loss of mobility and verbal skills • Possibly has seizures and tremors **• Has agnosia (can't identify objects or people)**

S/S: *Alzheimer's Disease*

Eye opening: 3 Verbal response: 1 Motor response: 6 Score = 10

Score the following Pt using the GCS: Your pt with a recent TBI has been in the hospital for 2 days. Today is your first time caring for this patient. When you arrive at the bedside the pt opens their eyes when you speak but is intubated so they cannot verbally respond. You continue your assessment and notice that the patient follows all commands. What is this patients GCS score?__________________________ Workbook

▪ Current therapies for MS treat a dysfunctional immune system using a variety of medications, including chemotherapy agents, to control the disease, decrease inflammation and pain, lessen symptoms, and slow progression. ▪ Fingolimod (Gilenya) is the first oral immunomodulator approved for the management of MS

What are the treatment options for ALS/MS?

▪ oxygen and suctioning emergency equipment available ▪ starting an IV access ▪ keeping the siderails up at all times ▪ padded side rails

What are seizure precautions

▪ Tremor ▪ Muscle rigidity (cogwheel movement) ▪ Bradykinesia or akinesia ▪ Postural instability

What are the 4 cardinal symptoms of Parkinson's Disease?

*Meningitis:* • Decreased (or change in) level of consciousness • Disoriented to person, place, and year • Pupil reaction and eye movements: ---Photophobia ---Nystagmus ---Abnormal eye movements • Motor response: ---Normal early in disease process ---Hemiparesis, hemiplegia, and decreased muscle tone possible later ---Cranial nerve dysfunction, especially CN III, IV, VI, VII, VIII • Memory changes: ---Attention span (usually short) ---Personality and behavior changes ---Bewilderment • Severe, unrelenting headaches • Generalized muscle aches and pain • Nausea and vomiting • Fever and chills • Tachycardia **• Nuchal rigidity** • Red macular rash (meningococcal meningitis) *Encephalitis*: has a high fever and reports nausea, vomiting, and a stiff neck. Assess for other signs and symptoms, including possible: • Changes in mental status (e.g., agitation) • Motor dysfunction (e.g., dysphagia) • Focal (specific) neurologic deficits • Photophobia and phonophobia • Fatigue • Symptoms of increased ICP (e.g., decreased LOC) • Joint pain • Headache • Vertigo

What are the manifestations of meningitis vs encephalitis?

▪ Male ▪ Over 40 years of age ▪ Family history (particularly first-degree relatives (e.g., parent, sibling) ▪ Reduced estrogen levels ▪ Exposure to pesticides, herbicides, industrial chemical, and metals as well as well water ▪ Traumatic brain injury ▪ Brain tumor or other lesion

What are the risk factors of Parkinson's disease?

▪ nausea ▪ photophobia (sensitivity to light) ▪ phonophobia (sensitivity to noise) ▪ osmophobia (sensitivity to smell) ▪ visual changes ▪ intense pain in one side of the head (unilateral), worsening with movement ▪ lasts 4 to 72 hours

What are the symptoms of a migraine?

(think tyramine foods) ▪ red wine ▪ caffeine ▪ alcohol ▪ MSG ▪ chocolate ▪ yeast ▪ cheese ▪ lunch meat ▪ hot dogs ▪ smoked meats ▪ ice cream ▪ yogurt ▪ marinated food

What foods can worsen a migraine headache?

ALS is a progressive neurological disease characterized by muscle weakness, muscle wasting, and paralysis of respiratory muscles *MS* ▪ fatigue ▪ muscle spasticity ▪ diplopia ▪ scotomas ▪ nystagmus ▪ paresthesia ▪ areflexic or spastic bladder ▪ intention tremors ▪ gait changes *ALS* ▪ fatigue ▪ muscle atrophy ▪ twitching of the face and tongue ▪ dysarthria ▪ dysphagia ▪ stiff & clumsy gait ▪ abnormal reflexes

What is ALS and how is it different from MS

• Helps describe the patient's level of consciousness. • 3 areas: eye opening, motor response, and verbal response. • The lower the score, the lower the patient's neurologic function.

What is the GCS and what is it used for?

▪ *Dementia* is a general term for progressive loss of brain function and impaired cognition. ▪ *Alzheimer's disease* is the most common type of dementia, accounting for most of the chronic confusional states that occur in older adults, eventually causing complete disorientation, physical deterioration, and death usually associated with complications of IMMOBILITY.

What is the difference between Alzheimer's and dementia?

*Meningitis* is an inflammation of the meninges surrounding the brain and spinal cord. **Complication = increased ICP** *Encephalitis* is an inflammation of the brain tissue and often the surrounding meninges, affecting the cerebrum, the brainstem, and the cerebellum.

What is the difference between Meningitis and Encephalitis? **Exam**

*Seizures* are an abrupt, abnormal, excessive, and uncontrolled electrical discharge of neurons within the brain that can cause alterations in the level of consciousness and/or changes in motor and sensory ability and/or behavior. *Epilepsy*: the term used to define chronic recurring abnormal brain electrical activity resulting in two or more seizures. Seizures resulting from identifiable causes, such as substance withdrawal or fever, are not considered epilepsy

What is the difference between seizures and epilepsy?

• Improve mobility to provide self-care and not experience complications of impaired mobility • Maintain safety and an acceptable quality of life

What is the focus of care for Parkinson's patients?

▪ body's center for controlling movement, sensation, and cognition

What is the function of the CNS?

▪ provide communication from the brain and spinal cord to other parts of the body

What is the function of the PNS?

Surgery within 24 hrs. of injury to stabilize vertebral spinal column

What is the goal for initial treatment of a pt with an SCI?

• ABCs! • After an airway is established, assess the patient's breathing pattern. • The patient with a cervical SCI is at high risk for **respiratory compromise** because the cervical spinal nerves (C3-5) innervate the phrenic nerve controlling the diaphragm.

What is the priority of care for a pt with a SCI?

• Calcium channel blockers & beta-blockers - interfering with vasodilation, a contributing cause of migraine pain. • Beta adrenergic blockers & calcium channel blocking drugs - lower blood pressure and decrease pulse rate. **don't suddenly stop beta blockers** **ergotamine constricts blood vessels** **verapamil (CCB) is for prevention only**

What medication is effective in treating migraines? Why?

dopamine agonists mimic dopamine by stimulating dopamine receptors in the brain. ▪ Levodopa - for muscle rigidity ▪ Baclofen - for muscle spasms

What medication is used to treat Parkinson's? Why?

*Phenytoin (Dilantin)* ▪ Monitor the patient's complete blood count (CBC) and liver enzymes and assess for therapeutic drug levels. ▪ Most AEDs can cause leukopenia and liver dysfunction. ▪ Teach the patient to observe for and report beginning gingival hyperplasia and perform frequent oral care to prevent permanent gingival damage. **do NOT stop abruptly**

What medications will prevent a recurrence? a. What do we need to know about this medication?

▪ IV or IM of lorazepam, diazepam, midazolam, and clonazepam (BENZODIAZEPINES!)

What medications will stop an active seizure?